Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Thursday, May 01, 2008

All this talk about a right to free healthcare got me kind of mad because I didn't believe it existed under our constitution. I also thought that patients should bear at least some of the burden for maintaining their own health and paying a reasonable fee either for insurance, or to physicians who treat them. Boy was I wrong! Witness the genius of America!

The Bill of Rights

Amendment I Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances. And all humans within the border of the United States have a right to free health care.

Amendment II A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed. Health care for free is a right for any organism with 23 chromosomes found within the borders of the United States.

Amendment III No soldier shall, in time of peace be quartered in any house, without the consent of the owner, nor in time of war, but in a manner to be prescribed by law. Doctors are required by federal law to see and treat all patients regardless of their citizenship, state of intoxication, assaultive behavior, or ability to pay for said care.

Amendment IV The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no warrants shall issue, but upon probable cause, supported by oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized. Doctors are to accept 30 cents on the dollar for their services. Dentists, Complimentary and Alternative Medicine practitioners, chiropractors, and life-coaches are to be reimbursed at 100 cents on the dollar.

Amendment V No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a grand jury, except in cases arising in the land or naval forces, or in the militia, when in actual service in time of war or public danger; nor shall any person be subject for the same offense to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation. The right to free health care is universal while in any state, territory, or possession of the United States. The right to payment for goods or services delivered is universal except for physicians who are greedy, rich bastards and should be held in the lowest esteem especially by the uninsured, addicted, politicians, liberals, and attorneys.

Amendment VI In all criminal prosecutions, the accused shall enjoy the right to a speedy and public trial, by an impartial jury of the state and district wherein the crime shall have been committed, which district shall have been previously ascertained by law, and to be informed of the nature and cause of the accusation; to be confronted with the witnesses against him; to have compulsory process for obtaining witnesses in his favor, and to have the assistance of counsel for his defense. The right to sue physicians for negligence occurring in the delivery of free health care shall not be abridged unless the physician guilty of negligence is employed by the United States Government, in which case the plaintiff is shit outta luck dude!

Amendment VII In suits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved, and no fact tried by a jury, shall be otherwise reexamined in any court of the United States, than according to the rules of the common law (except for physicians, who may be forced to settle lawsuits by their insurers or surrender their privileges, or insurance and therefore their ability to practice). Also, it is hereby mandated that physicians have no right to sleep, or to the pursuit of happiness.

Amendment VIII Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted. An exception shall be made for physicians, especially physicians in training, who may be imprisoned by their hospitals and kept awake for up to 72 hours at a time while performing surgery or fetching stool samples.

Amendment IX The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people. Did we mention that primoallopathic health care for all is a right?

Amendment X The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people (physicians excepted, of course).

50 comments:

Free health care isn't a right. It is a privilege. Health care isn't intrinsically the provenance of the government.

Unfortunately government has crept in and crapped things up. There is no one giant solution or bandaid for the problem as certain political factions would have us believe. National health care will just screw things up even more.

Somehow reasonability and responsibility must be brought back into our health care system. I don't think anyone wants to see people with true medical needs die unnecessarily or suffer because they cannot afford health care. At the same time, so much money is wasted treating crap and garbage that isn't medical in nature.

Somehow there has to be an answer that allows us to be compassionate humans without taxing our nation into socialism.

I don't have the answers, but I know what the end picture should look like. I just don't have a clue how our country can get from point A to point B.

Wow....am so happy happy that as a cynical, almost burnt out ER nurse like myself found you guys. It is comforting to know that I'm not the only person out there that thinks anyone that has ever worked for Press Gainey and/or JCHO deserve to spend eternity in the seventh circle of hell.....and what it up with that Dr. Peele lady.....I do go to therapy thank you very much...it's called pancakes and beer with co-workers in the AM after a very bad shfit. I would put much more faith in Jim Bean and Jack Daniels after reading her crap!

Now onto this healthcare mess. As a passionate libertarian...I just don't get how people feel entitled to "free" anything. I really think liberals are working on turning our country into a giant assisted living center....without the arts and crafts session. Don't people have the philosophical common sense to understand that when you tell someone they must offer a service or their time for free.......that that is a little something called SLAVERY?!? I have a t-shirt that says "Don't ask what your government can do for you period"

Do you think my ER will let me wear it?

I sometimes wonder if liberals have actually read the Constitution or understand the intentions of our Founding Fathers.....last time I checked Marx was not hanging out at Monticello with Jefferson.

You are so right, people should be made responsible for keeping their health up to scratch. Sadly some conditions like obesity etc is a major issue today. Obesity if not through a health concern is a health matter that can be prevented.

I don't know what has happened to our society. It has turned into the society of entitlement: everyone (broadly stroked, of course; there are exemptions all over the place but it's the extremes on this that make us crazy) is entitled to free health care, disability, etc.etc.etc, and they don't have to work.

I believe that you can blame the sub-prime mortgage mess on this sense of entitlement (sorry, I know this is off topic, but it really bugs me). How do people that have two incomes generating 100,000 afford a 600,000 home? That old rule of home 3x salary works, but people feel entitled to so much more....then, they blame it on the nasty bankers. The bankers are at fault for being STUPID in lending practices, but people need to eventually bear the responsibility of their decisions without a govt. bail out. Is someone going to give me money for being responsible? I thought not.

The entitlement in medicine goes on and on....I am entitled to free care even though I won't follow the directions when given; when I am non-compliant, I am entitled to blame the doctor for the bad outcome. I am sick of hearing about lawsuits. People are obese. They don't want to exercise or eat well. They want a pill. I have yet to see a diet pill that doesn't eventually have a significant side effect but that's what people want....I guess when that side effect is found they know that they can be a part of the lawsuit against the drug maker. Yeah, that's how they are going to make money! Having jobs is so....boring.

There is scorn for the younger generation of physicians that wants to have a life with family. People don't get it. After being threatened with lawsuit just because PEOPLE DO DIE and IT'S NOT MY FAULT, one needs a break. I am tired after being awakened at 3 am because a patient thinks that's a good time to tell me that she doesn't want the scheduled CT scan or needs a med refill (courtesy, people....besides, I can't cancel your CT at 3 am). I am human. I need sleep. I also need regeneration time from the stress.

I work in a community with a "poor payor mix." We give a LOT of free care, working hard to obtain drugs for our patients. An occasional thank you goes a long way. When people who aren't paying me threaten to sue....that has an incredible damping effect on my empathy and desire to continue to provide free care. No one talks about that (except ER docs, but it happens in the clinics, too). When people are griping that they can't get into see doctors, little do they realize that those in front of them may have caused the empathy/sympathy well to run dry.

I value my sleep and if I do not get enough for too many days in a row everyone around me pays. For that reason alone I could never be any kind of doctor because I would be so irritated/crabby all the time I would be no good to anyone. Once again, I say thank you for everything you do. I am amazed that anyone puts up with the crap you guys do and continue to help others.

This is all happening due to the Baby-boom generation "coming of age" (ie getting old as fuck). This, The Greatest (at being hypocritical and selfish) Generation, brought us "the sixties", where stupid hippie chicks were fooled into having sex with horny dudes in the name of "free love". They didn't ACTUALLY think they would change the world, they just wanted an excuse to blow off studying, smoke pot and have drum circles.

Now these morons are a demographic force. Now that they are old and financially secure (having, predictably, given up the dream of a Marxist society for BMWs and Lattes) they expect us to pick up the tab for their full body MRIs and virtual colonoscopies.

We need a full-on "Logan's Run" to happen so we can "Renew" and get rid of these self-involved, liberal (except when it comes to things that make me uncomfortable), hippie-turned- investment-banker-but-still-votes-democrat-because-I-am-guilty-and-stupid, aging commie bastards.

911 Doc, BRILLIANT! I personally believe that all U.S. Americans, such as, cannot find healthcare in America because most U.S. Americans, don't HAVE healthcare. Sorry, I digress. ETOTHEIPI, briliant as well. Americans are used to a lifestyle that we did not grow up with in middle-class America. Now, most middle-class to upper-middle-class families have one or two nice, big SUVs, a few 54-inch HD flat screen TVs, multiple I-Phones, etc, yet bitch and moan about paying $20 to see the doctor. WTF??

Look, sorry to disagree, but if we have to compare track records, what exactly did conservatives do for this country?

Let's see, expensive war that is not even included in the budget, economy in toilet, increasing unemployment...oh, wait, Reagan was the real conservative, not the current shrub. How did he do? Oh, yeah...the eighties. They were awesome. Same problems.

Say what you want about Clinton, I think the both of them are sleazy scumbags who will just as soon sell out their ideals for money as protect the people, but the 'conservatives' that have been in our government haven't exactly earned my trust.

Now, healthcare is certainly screwed up. But, given how well Bush and his conservative buddies have run our economy, our national policy, and our military, I somehow don't seem to believe that they will do the right thing by the healthcare system.

The whole entitlement issue--point taken. But US citizens also think they're entitled to gas that only costs $1 a gallon, cheap SUVs, complete and total cell phone coverage without paying for it...and so on. You can't hold liberals responsible for that. Baby boomers are just as silly to young liberals as they are to young conservatives.

Rising from my sick bed to shout a weak "huzzah" to all docs. Dammit, you guys need to be paid 100% for your hard work. I still think a Boston tea party is in order. Instead of tossing tea in the harbor, can't we toss in the politicians and insurance execs?

Returning to bed to watch Fox News Channel cover the May Day Illegal Alien marches and growl...

a. war not included in budget? hasn't congress come through with appropriations for the war, ie, it is not unfunded?

2. economy in toilet?? growth of 0.6% reported yesterday which is slow but TOILET?? and the dow cracking 13000 today. gas prices high because liberals wont let us get out own oil or build nuclear plants. seems pretty clear to me.

3. reagan saved the country from the toilet that jimmy carter put it in. no serious debate even on the left about this now. soviet union defeated. hope returns. taxes cut. revenues to fed. govt. increase. hmmm. and clintons are not trustworthy but the 'l'il bush' is not either? how so? what's he lied about exactly?

4. your final point is 100% lost on me. everyone might want gas at 1$ a gallon but they don't get it! they may want free cell phones but they don't get them... they have to pay. not true in medicine courtesy of EMTALA.

5. finally, in terms of what conservatives did for this country... hmmm. got us out of vietnam, admittedly without a victory, but got us out at the demand of the liberals and somehow are now blamed for it... got us out of the stagflation of that idiot carter... got us out of a losing battle with the USSR by winning it, passed welfare reform by cramming it down clintons throat and against his loud protestations, didn't send us into a war for show in bosnia, did actually respond to terrorist attacks on our troops and our people, do still talk about personal responsibility though i agree that most politicians forget about this, cut taxes again in bush's first admin and increased federal revenues again while providing relief to folks who actually hold jobs, continued to prosecute a war against our sworn enemeies whou would kill you and me and our families in a heartbeat if they were given the chance. we are killing them there rather than here.

there, that's a good list. meanwhile the liberals call our soldiers 'nazis', try to do away with tax cuts so they can buy the votes of those who benefit from large governement entitlements, in the process try to raise my taxes and i think i pay enough thank you very much, campaign on nebulous issues like 'change' and offer no specifics because liberals can not be liberals in public and get elected... they are elitists who think they are smart enough to weild incredible power and act like little emperors. they don't think folks are as smart as they are and they don't think the 'average joe' can do anything without their help. they are sick and deluded and power hungry.

Anonymous Dr, needs to get an advice nurse to screen his calls for nimrods that want to cancel their CAT scan at 3:00 am. The only people up at that hour are MDOD regulars. Hi Lynn-still sick? Me too. Happy May Day.

I heard John McCain talking today about health care reform again. He once again was emphasizing the need to bring free market and consumer choice back into health care. Do you think he actually gets it? Could he actually get elected and would he try to fix it? I sure hope he's not just saying things to get elected.

BTW, my hospital "Chief Administrator in Charge"(CAC)just "retired" after a blistering attack job by local newspaper. Perhaps desedrved, perhaps not. BUT, he "retired" effective this summer after being paid $700K+ this year and is guaranteed the same thru NEXT summer to continue on as a "consultant"Don't know about you guys, but I don't know a WORKING DOCTOR(ie not a plastic surgeon, radiologist, etc) that makes $700K!!!!Word up Paisons..Go to medical managent school!!

Actually, I don't think anyone really claims there currently is a Constitutional right to health care, but Hillary Clinton wants to make a Constitutional amendment so that happens. *Sigh*

Her argument was that being sick and losing one's insurance is form of discrimination. I can't say I've ever personally HEARD of someone losing their insurance because they were sick, but liberals have...

When will people realize that they are owed NOTHING by another human being. They are owed NOTHING that they cannot not obtain through their own sweat, blood, and tears or through the VOLUNTARY charity of another.

When will people realize that freedom is more than having the right to pick your favorite American Idol and/or choosing between several cell phone plans. True freedom means being able to succeed without meaningless government regulations standing in your way....it means being able to FAIL also and to be responsible for your failure.

Freedom is messy, hard, , insecure, scary, dynamic...it also the only way to live for the non coward. I love the motto of New Hampshire (it's on all their license plates) "Live free or die"

Great post. I must disagree however. I believe, like our founding fathers, that we have a right to I-phones, flat screens, gov't funded abortion on demand, mustard on our biscuits, and free health care. Just read the Constitution. It's right there.

Just reread for 3-4th time what I consider a must read for anyone who loves liberty, God, and country (not for your average dipshit, tree hugging, cap and trade, Nancy Pelosi lovin' liberal) - The Conscience of a Conservative by Barry Goldwater. Aside from the Soviet chapter, which he accurately predicted would fold when faced with a militarily and economically strong America, everything he said rings true today. I wonder how many history courses in high schools or, (laugh) colleges the book is discussed in. I nominate it for M.D.O.D. book of the year.

Fun fact- every day in the U.S., 50,000 lawsuits are filed, costing each american family on average 3,400 dollars per year.

Hey guys, I was in college less than a year ago. You know what that means??!?! Yessss, that's right, I've had many a "political" discussion at Ruby Tuesday's. Some were civil, but I did see a couple break up during one. All were revealing.

In case you were wondering about the general attitude of the 18-24 demographic on this issue, my experience has been this: significant majority feel that free healthcare is a good thing. I say "feel" instead of "think" because that's really all they're doing, there's no way in hell they've given it any thought/research. This view is bolstered by the fact that major media outlets provide approximately 17 seconds for two well-known politicos (but not docs or economists or even constitutional experts) to scream at each other about the pros and cons before some cashcow moderator lets us know that they'll be right back after some ads from Robert Jarvik. It takes no effort to believe what's on TV or some blog, and the average kid my age gets honey glazed eyes when I bring the subject up. As horrible as this is, it's not the issue that sickens me. The real idea that portends the collapse of of life autonomous from gov't, in my young opinion, is a view that I've heard spouted off many a time over southwestern spring rolls- the Constitution "gives" rights to citizens. It bothers me to extent that I'm posting like some 48 year old libertarian from Idaho. I'm not 48 yet.

Lots, lots, lots, lots, LOTS of young people these days associate the Constitution only with the establishment of certain branches of gov't and the doling out of certain rights, not with the fact that it basically articulates how citizens interact with gov't. All these amendments limiting federal power, hmmm, I wonder why? You know where this goes, right? Get enough positive press, and kids don't see big gov't as a two-faced Janus, they think it's our country's official philanthropist. People should have free healthcare- politicians say that they can give it to us AND the needy- that sounds good, plus I'm young and want to be politically active so I'll go vote for that. "Cautious," "judicious," and "patient" aren't usually synonymous with youth. Maybe we'll grow out of it just in time for our entitlements to kick in.

Hey S-Cat. Do you ever watch CSI? On the episode tonight an older couple who were murdered by a rodent had a cat that they named Shrodinger. HA. Made me think of you. There was way too much cyanide in that episode. And Jamie and Adam from Mythbusters. They wrapped up the whole random thing with string theory. The people had green blood. It was out there.

>>Talking about shooting, I am sure I am going to be shot down for stating this:

Physicians payment nonwithstanding,(yes, you should be be paid for services rendered. Absolutely.)I really do not see what the mass panic hysteria about "free" universal healthcare is. Those who feel entitled to everything without having to work for it already get free healthcare and the rest of us, well, instead of paying high insurance premiums for ourselves AND taxes for the parasites, we would be paying higher taxes. Same cost to us, really.

So this vendetta against universal healthcare, is it powered by the insurance industry that fears its profits would melt?

The French and the Canadians have universal healthcare, and I really do not see either country in dire economical recession nor do I see French and Canadian citizens dropping dead like flies.Their universal healthcare is not totally free by the way.

This is not a political post, so please do not drag any of the candidates into this if you wish to respond.This is just a candid observation from someone who has used all 3 systems.

I am open to rebuttal from anyone who also has used a healthcare system other than the US one.And "When I was on vacation for a week in Vancouver/Cannes and I sprained my ankle" does not count. Neither does the example of the cousin of of your hairdresser's neighbor.

"So this vendetta against universal healthcare, is it powered by the insurance industry that fears its profits would melt?"

You're kidding right? You don't think doctors could see through the propaganda? Or you think they're in on it?

I think it's kind of convenient to disqualify anyone who "hasn't used" any of those systems. You have disallowed us the use of any stories of friends or family members. Are you counting on there being no one as widely traveled as yourself?

You can easily research journal articles and news reports on MRSA in these hosptials yourself. You can also find out for yourself how long people wait for surgeries and medical treatment, or how people hop down to the good old USA to use our MRI's. People die waiting for treatment in those countries. People are taxed a ton more in France. No thanks.

Saying that only people who have lived for a substantial time period in one of those countries is kind of stacking the deck right? Why do the libs keep telling me that I can't make up my own mind? Since you don't want the anecdotal stories of my Canadian friends, I'll keep them to myself. I am quite capable of comprehending what goes on in one of those health systems without having lived there.

When you give a right like healthcare to an individual, you are obligating another individual to provide that service. Liberties should be obtainable by all and an obligation of none. Thanks 911DOC, I enjoy reading your stuff!

This might be the best place for treatment, if you are independently wealthy or dirt poor. The rest of us have to take a number and go through a lot of red tape when a serious illness happens. Don't take it personally, I am not attacking doctors, I am attacking a hugely messed up and unfair system.

I am going to open a little bit the curtain of my life: we lost our only child 2 years ago.I will always wonder if he would still be alive, had we lived somewhere else, where top of the line healthcare is more easily accessible to all. Or maybe not. Curtain closed.

As for the feather dusters, they are not made uniquely of chicken feathers. Some are made also of duck, goose and ostrich feathers.So why explain only to the chicken?

Amy, I'm so sorry for your loss. I've often felt I would never recover from the loss of one of my children, and am awestruck at those who do find a way to move on.

Just a couple of observations (I'm a doctor who worked 9 yrs in a VA hospital--a big impetus toward this former registered Democrat becoming conservative!!--then, 6 years at one of the world's great cancer centers, M.D. Anderson in Houston):

Many people in this country get first-rate care--it does depend on where you live, and how much moxie you have in working "the system";

Many others, poor and well-off alike, don't get great care;

I know lots of healthcare pundits like to make a big thing of our lesser life expectancy here in the U.S., but from where I stand now, as primary care physician to some ultra-frail 80 and 90-somethings, I'm not sure that extra 1-3 years would be all that great!

And, finally,

Despite the billions spent on research at the NIH and elsewhere, we still don't know shit about why some 30-year-olds die of cancer, some children die of meningitis or any of another 100 diseases, and why some smokers live to 80.

you mistake our purpose. sure, we will bash folks here, but we also bash each other. if you are telling the truth and you lost a child two years ago then i am terribly sorry. i really am. the absolute worst part of my job is telling parent's that their child died. usually i do this in the setting of trauma, but i do it too frequently with SIDS, and, unfortunately for all involved, with common illnesses with a delayed presentations.

'my child died' is an argument stopper. in fact, it bothers me so much that i have to ask what happened?

being a part of the 'system' that you believe failed you, and seeing death about once or twice a week (sometimes more) i am baffled as to what could have happened that was missed or maltreated. being a husband and a father i will tell you without hesitation that if any of my family were to be ill or injured that there is no place in the world i would rather they be treated than right here. cold comfort for you i understand, but i know medicine, and i'm not flying my sick child to france or canada for treatment. the best in the world is just down the street and that is so in all fifty states.

i'll even extend that and say that and say that for children of any socioeconomic background with any illness or injury that this country is the best place for them to be diagnosed and treated. everyone really does have unlimited access to care in this country. it is, in fact, why we are in a mess.

for instance, i took care of a woman the other day that all of us know. she has many clones all over the country. she, through a series of bad circumstances, poor education, and bad choices, has real disease and fake disease. she has no money and no insurance. she has diabetes and smokes and drinks. she has headaches and hypertension. her kidneys are failing and she will soon need dialysis. she takes the ambulance in to our ER about once a week. her bills are now in the millions of dollars. i have paid for her care, and, if you pay taxes, so have you. but she has not, nor will she.

i heartily agree with you that folks in the lower to middle income brackets are in the worst place to be in terms of insurance. but this is because of my patient above and people like this guy (courtesy of EMTALA). also, many young, otherwise healthy folks take a calculated gamble and go without insurance hoping they don't need it. i was uninsured from 21 to 26.

but back to it... to pay for the "free" ER care insurers raise prices, hospitals raise prices, and doctors raise rates. in the meantime there's always a lawyer or two waiting for me to screw up and when i do it matters not whether i was doing gratis work.

there is absolutely no way for supply and demand to work as the government has mandated that there be unlimited supply of excellent care.

amy, i do not think you are attacking doctors, but i believe you make a mistake if you think, as i think you do, that 'someone has to do something'. this usually means the government, and if you think a governmental solution is a good idea then that is where you and i part company. someone does have to do something... "each of us has to take responsibility for our health, and each of us has to say "no" to anything that takes us, as a society, away from personal responsibility in any form. so simple yet so hard, and a very hard sell to anyone used to being given stuff by the government.

EMTALA got us in this mess and, as usual, hard cases prove to make bad law. EMTALA may have served to prevent 'patient dumping', but at the cost of driving doctors off call, out of medicine, or into their own surgical centers where they can actually get paid for their time. i do not blame them.

to get back to my friend above with the end stage renal disease who uses 911 about once a week, if she had to pay ten dollars for every visit to the ER the economic incentive to actually get a primary physician would magically appear and even she would begin to understand that her ambulance rides and ER visits are not 'free'. she might even have to cut down on her cigarettes. right now she comes to the ER because she knows that it's cheaper than going to a 'regular doctor' (primary care physicians fall outside of EMTALA). she's wrong on many accounts, but also very wrong about her health... we are the exact wrong doctors to manage her chronic conditions. we are the right doctors to manage her stroke or heart attack (which are coming very soon by the way).

in short, the only thing i can think of that may have befallen you and your child is malpractice. i can certainly understand if your pediatrician missed something and if that is the case then again, i am terribly sorry. we all miss things and we hope and pray we won't miss something life-threatenting.

but i can not understand, apart from that, how our 'system' failed you. any kind of leukemia or other cancer is best treated here. any form of congenital disorder is best treated here.

i do not expect you to answer as it may be too painful for you and that's okay, all i'm saying that is the frontiers of medicine are still being pushed back in the west, and then, primarily in the united states.

it is precisely because of the development of individual medical centers with research institutions attached that we are the best. it is precisely because there was once money in medicine that we are still privileged to the results of it being spent in medicine. when the money flows without being chopped and cut by 18 different federal agencies then progress is made. yes, NIH grants and government funded studies are hugely important, but so are drug company funded studies and money from the private sector. hospitals die if they do not at least pay for their expenses. if they make money so much the better, there's more to spend at the margins. right now, there are no margins.

finally, doctors go through years of hellish training to save lives, yes! but also to have lives, and to practice the best they know how. take the money away and you will still have good physicians, but take the autonomy away and make us government employees and instead of excellence in our physicians you will have mediocrity.

in fact, when i want to stop working like a madman at all hours i will go and work for the VA. the pay will be a little less but the patients will wait on me and not vice versa (i mean no disrespect to VA physicians... i get my care there and it's pretty good, but anyone who has worked in the military medical corps outside of wartime or in the VA will tell you that it is rationed care(and maddening for patients).

Wow... I guess I brought this upon myself. I broke my own rule of never sharing that information with strangers.It was late, Mother's Day is approaching and I am a mess, I let my guard down.

As I am emptying this box of Klenexes, here is my response.

I do not criticize the level of helthcare in the US. It is of the very highest level and rightfully so, it is also expensive. People with the highest incomes have access to the best of healthcare, housing, lifestyle. Fair enough.

Where my claws come out is when the rest of us are inequally treated when it comes to the access of care.The lady you mention gets excellent care for free. With my (and your) money.I work, I pay taxes, I take care of myself, I work out, yet if I were to got to Emergency for a car accident, for instance, my co-pay would be 10% of the bill. A small fortune, I am sure, depending upon what shape I am in.Then if I needed rehab or some expensive long term care, my husband would have to talk to and fight with the same insurance people Lofty argues with, so my care would be covered, even if at a ridiculously low rate.

You say:"i believe you make a mistake if you think, as i think you do, that 'someone has to do something'."You bet I do.

I will end this with janemariemd comment:

"Many people in this country get first-rate care--it does depend on where you live, and how much moxie you have in working "the system";

Many others, poor and well-off alike, don't get great care;"

I am sorry I threw you a curve ball with my comment about my son. As I mentioned at the beginning of this, I should never have talked about it in the first place. There are plenty of examples of unfairness in the way healthcare is available. That was not fair on my part.

amy, i agree with you sweetheart, but you misquote me. i said that the worst place to be in our counrty's current mess is someone with a middle income and a job. you are right, you are funding helath care for all. the reason you are, is EMTALA, and the unfunded mandate to take care of all comers regardless of their ability to pay.

i also said that we all 'have to do something', not that no one needs to do anything.

also, my question stands though it sounds like you should not answer. what happened to your child that you were unable to access care?? what happened to your child that you were not appropriately treated and diagnosed? what cost was prohibitive? what hospital refused to treat based on $$?

your posts are not linked to any profile, you are posting anonymously with the name 'amy', please rest assured that none of us know who you are. in this context please do try to answer because i am very interested at the specifics of how your child suffered due to lack of access to care.

You are forcing me to break my rule again...I have to leave but just a quick comment I need to address immediately, because maybe I gave out the wrong impression: no hospital refused treatment based on $$. You have no idea (I think) how painful it is for me to stir all this up, especially at this time of year, but maybe later I'll try to give more details.

And I don't have a profile because it did not work when I first tried, not because I want to be under the radar. I just gave up.

If you'd like to stick to some generalities, how about some insights or things you wished your child's doctors knew or did? Any behaviors that weren't exactly empathic or informative?

There are at least half a dozen plus docs reading this blog (me,and the writers LOL) but more likely dozens more. We aren't perfect, and I know I often don't live up to my ideals as far as being a compassionate and capable physician. One day when I was on call and speaking on the phone to a patient who paged me, after I hung up my husband said, "You weren't very nice to that person". And you know, he was right! So I'm trying to be kinder on the phone to patients who page the on-call doc and get me calling them back. (This was also amazing as my husband isn't alway so diplomatic in his 'feedback' to me!!)

On the one hand, I am convinced that we lost precious time when we decided to go through our health insurance to change doctors and we had to fight and argue to get nowhere at first. Hindsight tells us we should just have seen another doctor as self pay and not gone through the "high school dropouts." (We had to deal at first with a family doctor who just knew this had to be of no importance and I was just a neurotic mother.)

On the other hand, it really does not matter anymore. No one can turn back time.

When we finally accessed good care, cameras came out of the woodwork, curiosity drew a university professor and that kind of interest was not a good sign. Usually when caught on time, even though very serious, it is fatal only at a very low percentage.Things just fell into place to give us the worst possible outcome.

we are not forcing you to do anything. please understand this. i am not asking you these questions to dredge up pain for you. i am asking these questions because you have asked some questions and made some assumptions that are commonly made about health care in the united states and well, it's my life.

we are mostly of one mind here about the things that are wrong and the things that are right in health care. i am NOT going to let our blog be used by others (not you, but we do have like, thirty readers, and one of them need only push a button to send this right into hillary's meaty, cold, little hand) to push their political agenda. it's getting to be election season, and while i have no illusions about this blog having ANY influence or power, it could provide a convenient sound bite for obama or hillary if the 'blogging doctors at MDOD' agree with you that our system is so messed up that children die needlessly.

secondly, and kindly, i DO, actually, have an idea about how painful this is for you. i have to tell parents when their children have died in the ER, i have to tell brothers, sisters, moms and dads. i see the pain, i hear the screams, i am the bearer of the worst news one can hear so i have an idea. it is a mistake to disqualify those who have not suffered your particular tragedy from having an opinion that might be worth listening to. it sets you up for being completely alone, or, it sets you up for getting caught up with others who have suffered your loss and have been unable to let go. i have no idea if i am describing you, amy, but it is possible to get stuck in your recovery in a sea of black 'what ifs?'.

also, let me suggest this to you. while we are all loudmouth, sophomoric clowns here, we are at least clowns who happen to be very good doctors. i am not saying this to toot my horn, as i have done my best to remain anonymous. i am saying it to let you know, just like janemarie did in her comment above, that if there is stuff that happened with your child that you wonder about. if you are not sure if your child received the right treatments in a timely fashion, if you are wondering anything like that, then we can offer you very educated and expert opinion.

most of us here are ER docs but etotheipi is a pathologist. his bailywick is to know everything about every human disease (except how to fix it), and he knows the statistics and likelihoods and prognoses as well. he knows it cold.

how 'bout this. even though you are as anonymous as one can be in a comment section and you should have no fear about that; if it would be easier for you then email me at the address on the top right of the blog. i promise to keep whatever you send me between us AND i promise that if what you tell me makes me change my mind about what is wrong with our system and how to fix it (or if we really aren't as good as we think), then you will have a very public and humble apology from me right here.

finally, let me tell you the first thing i tell family members when one of their loved one's has died. i tell them that it was not their fault. outside of murder it really was not their fault. it's not your fault amy. if you favor me or this audience with more of the story i am betting that whatever accident or disease took your child from you was aggressively and expertly treated and that there was nothing more that could be done anywhere on this planet. it's not your fault.

your comment has me really thinking and i am very interested but do respect the fact that it is hard for you so will just hope you can tell us a bit more when you are ready.

have you talked to an attorney or had a physician expert review the case? i know that doesn't change anything but now i am wondering about honest-to-goodness malpractice.

on the subject of the whole 'primary care gatekeeper' concept so touted as the panacea by the clintons in 'hillary care part 1', i have lots to say. it is enough for a few posts so i will just scratch the surface here.

suffice it to say that i think the concept of the primary care gatekeeper was fundamentally flawed and even ridiculous. it betrayed a complete lack of knowledge about medicine, how doctors practice, and how excellence and near perfection is acheived.

This seems a little out of place now with where the conversation via comments has gone, but I want to point one thing out. Yes, a very large group of people like to spout off about our life expectancy numbers. But consider this: the good ole US of A is tops in the world in violent crime, drunk driving, suicide, aggressive driving and reckless driving; all things that, either directly or indirectly, impact our life expectancy numbers. When a 17 year old "gang-banger" is murdered on the street, this impacts our LE as much as a 17 year old dying from leukemia. Not really a fair comparison when thought about from that perspective. Just a point to consider: when looking at statistics, ALWAYS make sure to look at the numbers used to make those stats and how they are calculated. This simple research can change what the stats are actually saying. So much so, that if you remove deaths caused by violent crime, drunk driving and suicide from the life expectancy numbers, the US actually becomes #1 in the world!! I don't remember the numbers, but I did find at one time all the percentages for all the countries broken down by cause of death. When this is taken in to account, I don't see how you can possibly say the healthcare system is in any way to blame.

On a more serious, non-political note, my heart goes out to you Amy on the loss of your child. By profession, I am a Pediatric ICU nurse, so I work with parents who have lost or are in fear of losing their child on a daily basis. I too am very interested in the specifics of your situation when you are feeling up to sharing them. I will make the same offer as 911doc did for you to email me privately. I am not an MD, but I work everyday with pediatric physicians of every specialty and have seen and experienced quite a bit, so I have more pediatric experience, admittedly without the education 911 has. Perhaps between the two of us, along with all of the other great people here, we can help you come to a better understanding of what happened which can help ease some of the pain. Not pushing here, just letting you know I am here for you if you'd like.

THE RECENT STUDY ON LIFE EXPECTANCY IN THE US SHOWED MOST OF THE DISCREPANCY WAS DUE TO CHOICES PEOPLE MAKE (SMOKING, DRINKING, DIET, ANAL SEX)... NOT ACCESS TO HEALTH CARE. I CAN'T MAKE CHOICES FOR PEOPLE, ONLY THEY CAN.

I think the primary care doc as gatekeeper can work really well in some instances. When my idiot son fell off a cliff, his pediatrician was invaluable to me as an advisor and a friend: We trust him and his opinion, and I was very grateful that I didn't have to pick and communicate with the many specialists and surgeons that we ended up seeing. We also communicated well, and he listened to my concerns and preferences. Same with my internist. I love you guys.

Dr. Cat, I read that too, that the rate of anal cancer is going up because of a an apparent change in people's sexual practices. I wonder what the public service announcement will look like? And I agree with your comment.

I understand what happened, it was explained to me and I did some research on my own when it was all taking place. It will be 3 years in August that he died and after the initial shock, I thought I was doing OK, considering... Then I have been recently hit by a tidal wave of grief, which I even did not see coming.I have no need for further explanation (thanks for offering), partly because I think I know, partly because it really does not matter anymore, but I also understand your professional interest, so I promise if I ever can get over reliving this as if it was happening all over again, I will contact you to give you information.I still cannot believe I blurted this on a blog of total strangers, a sign that maybe finally I am losing my sanity. It sure feels that way. Again, thank you.

Amy, I haven't lost a child, but I was just writing in my blog about something that happened 29 yrs. ago (the disappearance/death of my brother and Dad), and I was just knocked out with grief. The pain doesn't all happen at once (though it feels that way), or it would kill us. I think it's normal to 1) talk to strangers about it 2) feel overwhelmed by grief years later. You never get over it or recover from it, you just get more functional as time passes. Take care, and I'd be happy to talk to you too.